Respiratory Therapists Inserting PICC Lines - page 6

Here in Arizona several of the hospitals have started an experiment, they are actively replacing PICC nurses with RTs and calling them "Vascular Access Specialists." These RTs will place PICC lines,... Read More

  1. Visit  CraigB-RN profile page
    1
    I'd have to say then that you must have only working in one very small place. I see respiratory or CardioPulonry doing A-Lines, Intubating patients. Assessing and recommending treatment for patients, having face to face discussions on best ventilator mode to use for a patient.

    Any argument based on a we're better than they are premise, is missing the boat and degrading to both professions. Yes I used to do all my own breathing treatments, and chest PT, and IPPB machines, and I also used to have a 10-12 patient assignment. Now I have a much smaller assignment but much more to do with those patients. i couldn't do it without reap there to help in their specialty area.

    In the last 2 hospitals I worked, One large one, and now a small one, the Bachelor trained RT's act as intensivist and lead rapid response team until I get there. Since a large percentage of crashes on the floor are cardiopulmonary that makes sense.

    Can I do everything that they can do. Despite them saying things are out of my scope of practice, when they aren't. I CAN do all the individual skills. But I don't want to. I've got other things to do.

    RT's doing PICCs are going to be driven by the market. I've been out of the PICC business for awhile now. It used to be if a nurse put a PICC in an inpatient, you couldn't bill for it. It was included in the basic room rate that included nursing. If this has changed I'd be interested in knowing. Resp can bill = greater reimbursement which equals more money.

    This is one are that lindarn and I agree completely on. Until we change how we're reimbursed, nothing is going to change.
    lindarn likes this.
  2. Visit  Vascular Access RN profile page
    1
    I can say no more than I have; I do not wish to reveal details out of concern for institutional privacy and reprisal. What I am warning is that institutions and individuals must check with the professional boards BEFORE "diving in." I invite anyone interested to look at the curricula in their respective states, and to READ their professional practice acts and rules and regulations. This step is imperative before permitting any new skill.

    I HAVE ABSOLUTLELY NOTHING AGAINST RESPIRAORY THERAPY AS A PROFESSION. As I stated last time, within their scope, they save lives and are an invaluable part of the healthcare team.

    And, no, RTs may not charge for this procedure, any more than nursing can.
    lindarn likes this.
  3. Visit  Asystole RN profile page
    1
    Quote from classicdame
    Has anyone bothered to check with the Arizona BON to see if this is a protected RN task?
    I was just at the latest Scope of Practice Committee for the AZBON. Arizona laws are a bit looser in regards to the medical world. There is no such thing as a "protected RN task" in the State of Arizona.

    The Board releases "Advisory Opinions" on nursing matters and shuns giving those opinions on other professions.
    lindarn likes this.
  4. Visit  lindarn profile page
    0
    I have never heard of, "Bachelors Prepared RTs". I have only known of RT being a two year program at a Community College.

    This is interesting if RTs are increasing their entry into practice to a Bachelors Degree, and nursing is still allowing individuals to enter the profession with only a Diploma. What does that have to say about nursing?

    I will bet, if RT goes to a four year degree program, there will not be the infighting, like in nursing, whether it should be a requirement or not. I will be that there will not be three entries into practice for RTs, if they increase their educational requirements.

    It seems that all other Health Care Professionals are leaving nursing in their dust. If nursing does not get their act together, there will not be a nursing profession for us to fight over.

    JMHO and my NY $0.02
    Lindarn, RN, BSN, CCRN (ret)
    Somewhere in the PACNW
  5. Visit  manusko profile page
    0
    Quote from lindarn
    I have never heard of, "Bachelors Prepared RTs". I have only known of RT being a two year program at a Community College.

    This is interesting if RTs are increasing their entry into practice to a Bachelors Degree, and nursing is still allowing individuals to enter the profession with only a Diploma. What does that have to say about nursing?

    I will bet, if RT goes to a four year degree program, there will not be the infighting, like in nursing, whether it should be a requirement or not. I will be that there will not be three entries into practice for RTs, if they increase their educational requirements.

    It seems that all other Health Care Professionals are leaving nursing in their dust. If nursing does not get their act together, there will not be a nursing profession for us to fight over.

    JMHO and my NY $0.02
    Lindarn, RN, BSN, CCRN (ret)
    Somewhere in the PACNW
    There are 4 year and 2 year programs available. There have been 4 year schools for several years now.
  6. Visit  MunoRN profile page
    0
    Quote from Vascular Access RN
    And, though they may "flush a device" (NS for the purpose of patency is not considered medication by the FDA, they may not administer any IV medication. So, if they plan to maintain patency, they aspirate first, always. If not, they are reaching outside their scope of practice.
    You lost me there.
    Last edit by tnbutterfly on Oct 4, '13
  7. Visit  MunoRN profile page
    1
    Quote from Vascular Access RN
    To MunoRN, do your homework. I have. There is a big difference between "on the job training" and foundational theory and practice. Please don't throw outcomes at me either. Publishing is a very political deal. And valid outcomes should be collected and interpreted by both internal and outside review. That is, end results reviewed and verified both by the department involved and another (quality, infection control, etc.) Also, outlying high risk or poor outcome incidences should be mentioned.
    There is a difference between on the job training and foundational theory and practice, but RN programs don't provide any PICC insertion foundational theory and practice except for a relatively small amount of vascular anatomy. Typically, an RN beginning training to place PICC's is at the same starting point as an RT.

    Publishing can be very political, although outcomes reporting isn't all that political, but the political nature of publicizing that data is exactly why I would expect to see any evidence that RT's produce poorer PICC outcomes widely publicized by any of the many Nursing groups that would benefit from this, but I have done my homework and there doesn't appear to be any.

    In terms of maintaining PICC's, I've only worked in one facility where the PICC nurses actually maintained the PICCs (dressing changes, Tpa, etc), but even then that was only during baking hours.

    Don't get me wrong, I'm very disappointed that we've been too inflexible to keep this arrow in our quiver in many instances, but while I'm a proponent of Nursing keeping it's role in healthcare, I'm more of a proponent of good patient care, and I've had too many experiences where a patient couldn't have a PICC line because it's 2:30 in the afternoon, so they have to get a central line placed only to have it replaced with a PICC the next day (so long as the next day isn't a weekend or holiday).
    Last edit by tnbutterfly on Oct 4, '13
    lindarn likes this.
  8. Visit  chare profile page
    0
    Quote from Vascular Access RN
    I can say no more than I have; I do not wish to reveal details out of concern for institutional privacy and reprisal.
    As I mentioned in my last post you have made several statements regarding respiratory care education and scope of practice. I am not asking for either your name or the name of the facility in which you work. What I am asking for is the state in which you practice. Until you do so, your statements regarding respiratory care practice in your state lack credibility.
    Last edit by tnbutterfly on Oct 4, '13 : Reason: Corrected quote
  9. Visit  Tnbelle56 profile page
    3
    It is disturbing to me that there are so many blurred lines between these professional disciplines. But, let me pose this to you...an ob doc, a plastic surgeon, a psychiatric and an orthopedic surgeon are all physicians. All have had some similar basic training but who would you want to perform your knee replacement? Of course the orthopedic surgeon, so who would you want to insert and maintain your PICC? Who would be available to troubleshoot, administer a thrombolytic, give nurses advice, teach patients how to maintain these lines at home, etc, etc, etc?
    NRSKarenRN, lindarn, and elprup like this.
  10. Visit  libran1984 profile page
    0
    There are LPNs at my hospital who place PICC lines too.
  11. Visit  manusko profile page
    1
    Quote from Tnbelle56
    It is disturbing to me that there are so many blurred lines between these professional disciplines. But, let me pose this to you...an ob doc, a plastic surgeon, a psychiatric and an orthopedic surgeon are all physicians. All have had some similar basic training but who would you want to perform your knee replacement? Of course the orthopedic surgeon, so who would you want to insert and maintain your PICC? Who would be available to troubleshoot, administer a thrombolytic, give nurses advice, teach patients how to maintain these lines at home, etc, etc, etc?
    PICC line training is now the equivalent of a total knee replacement? PICC line training is how long? Our ortho residents spent 5 years learning how to replace a knee.
    lindarn likes this.
  12. Visit  elprup profile page
    0
    Wow, my eyes have been opened.
  13. Visit  Tnbelle56 profile page
    1
    LOL, No, of course they are not equivalent to a total knee replacement! The point I was trying to make was that they should be done by those that can devote themselves fully to them and not by those that have their time divided into different directions such as having to keep up with RT responsibilities, etc.
    lindarn likes this.

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